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Forcing GPs to adopt half-baked e-health record a dud idea: AMA

October 16, 2015

The Federal Government has hit a major snag in its overhaul of the troubled e-health record system after the AMA rejected plans to link GP incentive payments to the adoption of the scheme.

The Government has proposed that Practice Incentive Program e-health payments be tied to doctor use of the MyHealth Record (MyHR) system being developed to replace the $1 billion Personally Controlled Electronic Health Record scheme. The PCEHR has been dumped amid dismal take-up rates among patients, doctors and medical practices.

But AMA President Professor Brian Owler said the MyHR system was far from fully developed, so using PIP incentives to get doctors to sign up was ill-considered and premature.

“The MyHealth Record is not at a stage where it can be adopted by practices, so it should not be linked to the PIP scheme,” Professor Owler said. “There are fundamental issues with the design of the MyHR that are yet to be fully addressed.”

The AMA has detailed a long list of problems with the current version of the system in a submission to the Health Department, including:

the ability of patients to remove information from view, making the record potentially incomplete and of no clinical value;

no flags to indicate if information has been removed from view;

radiology or pathology results are not yet included;

the shared health summaries are not automatically updated, rendering them quickly out-of-date; and

inaccuracies occur in the upload of data.

In addition MyHR, in its current iteration, remains an ‘opt-in’ system.

The reliance on patients to sign up for an e-health record was seen as a fatal weakness of the PCEHR, and a three-person review of the system recommended that MyHR be an opt-out scheme.

But Health Minister Sussan Ley has indicated that the opt-out approach will first be trialled next year before being adopted.

“It’s important that all Australians are signed up to ensure we have a functioning system, and trialling an opt-out model means we can do it carefully, methodically and ensure the appropriate protections are in place to give patients peace of mind,” Ms Ley said.

“If automatic registration for a digital health record in the opt-out trials leads to higher participation in the My Health Record system, the Government will consider adopting opt-out on a national scale.”

Professor Owler said this lengthy catalogue of unresolved problems with MyHR meant it was unfair to expect GPs to adopt it.

“Until the problems with the MyHR have been rectified, so that it is easy to use and offers real clinical benefits for patients, it is unreasonable to expect GPs to actively use it,” the AMA President said.“The AMA has been a strong advocate for a well-designed and governed e-health record which can deliver real benefits for patients, but the current MyHR model has well-known flaws that must be fixed.”

The AMA has recommended the Government focus on rectifying problems with MyHR rather than trying to force GPs to use a system that is cumbersome and incomplete.

Even when the system is complete and fit for use, the AMA has argued that, instead of using the existing e-PIP incentive, the Government instead create a Medicare Benefits Schedule item and a Service Incentive Payment scheme to promote its use.

To help establish MyHR, Ms Ley has announced the appointment of former National Mental Health Commission Chief Executive Robyn Kruk to head an 11-member eHealth Implementation Taskforce Steering Committee.

The Committee, which includes Dr Hambleton, will design, implement and oversee the establishment of the Australian Commission for eHealth.

For its part, the Commission will oversee the operation and development of e-health systems, including operating the My Health Record System.

Revised eligibility requirements for the e-Health Incentive are due to be announced in November 2015, and to commence from 1 February 2016.